Societies'desire to obtain a more youthful appearance has increased the demand for rejuvenation surgery. Many techniques have been developed attempting to improve aesthetic results and prolong the operative improvement. These techniques require extensive dissection not only of the skin and superficial facial layers but also the superficial musculoaponeurotic system. Thus, the duration of the operation and risk of complications, such as anesthesia of the ear, hematomas, facial nerve deficit, skin slough, infection and hair loss, increases dramatically.
One of the more common rejuvenation surgeries is the rhytidectomy procedure or facelift surgery. In facelift surgery, the soft tissues of the face and neck are widely undermined allowing for advancement of the facial and neck flap upward and backward. Again, such extensive undermining of the soft tissues of the neck and face may lead to complications such as hematoma, risk of facial nerve injury and skin loss.
Many have attempted to harness the viscoelastic properties of skin in order to maximize the amount of neck and facial skin excised and avoid the extensive undermining of the skin by stretching or expanding the skin intra-operatively. Such viscoelastic properties allow skin to stretch to a certain extent, but by virtue of creep, the skin will stretch further under the same load over a period of time. Unfortunately, intra-operative procedures limit the amount of time in which the skin may be allowed to stretch. If the skin is not allowed to stretch enough, the tension applied to the skin after completion of the facelift procedure may lead to the skin stretching by virtue of creep, thereby diminishing the aesthetic results of the facelift procedure.
Few intra-operative skin stretching techniques have been developed for preoperative use, but one skin stretching technique that has been utilized for preoperative use is the silicone bag expansion procedure or tissue expansion procedure wherein in the intra-operative procedure, a silicone bag is surgically implanted in a deflated position underneath the skin. The bag is then inflated with a saline solution in order to provide tension on the skin. After the skin has been allowed to stretch, the bag is deflated and removed, and the excess skin is then excised.
The tissue expander or silicone bag has been used preoperatively for tumor surgeries wherein the device is implanted in a surgical pocket, adjacent to the tumor, and incrementally inflated. Weeks later, the device is removed during the second procedure in which the tumor is excised. The additional expanded tissue is used to close the large defect created by the tumors absence. Two separate surgical procedures are required.
The inflatable tissue expander is associated with many complications arising from the additional surgical trauma required for creation of its deep subcutaneous pocket. The device itself is easily punctured, may leak or otherwise mechanically fail, appears cosmetically deforming when inflated, and most importantly, may destroy the overlying skin by pressure necrosis because there are no means of measuring the tension on the skin as a safeguard against over inflation. Also, in facelift operations, the optimal direction of traction for achieving the intended effect is upward and backward. A drawback, therefore, with an expansion device placed under the skin for rapid expansion is that the skin is stretched multiaxially. As a result, there is some dissipation of the stretching force because many collagen fibers, the fibers in the skin that allow the skin to stretch, are stretched in an unfavorable direction.
As previously stated, intra-operative procedures do not provide an ample amount of time to completely take advantage of the viscoelastic properties that allow the skin to stretch over a period of time. Also, the procedures do not maintain a constant tension or provide a reestablishment of the tension on the skin once the skin is stretched in response to the tensioning force. Therefore, it would be desirable to provide a preoperative apparatus and method for stretching the facial and neck skin prior to facelift surgery in order to maximize the amount of skin excised and alleviate the complications associated with the extensive undermining of the soft tissues of the neck and facial skin that occur when performing facelifts.